CARILLON ASSISTED LIVING OF WAKE FOREST LLC (NPI# 1639585649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639585649 |
| Entity Type | Organization |
| Organization Name | CARILLON ASSISTED LIVING OF WAKE FOREST LLC |
| Practice Address |
3218 Heritage Trade Dr Wake Forest NC 27587-4238 |
| Practice Telephone | 9195692101 |
| Practice Fax Number | 9195692102 |
| Mailing Telephone | 9195692101 |
| Mailing Fax Number | 9195692102 |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2014-09-15 |
| Authorized Official Name | MRS. KAREN ELENA MORIARTY (PRESIDENT AND CEO) |
| Authorized Official Telephone | 9198524000 |
| Is Organization Subpart | Y |
| Parent Organization Name | CARILLON ASSISTED LIVING, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311Z00000X | Custodial Care Facility | HAL-092-193 | NC | Nursing & Custodial Care Facilities |
| Street Address |
3218 HERITAGE TRADE DR |
| City | WAKE FOREST |
| State | NC |
| Zip Code | 27587-4238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710538160 | Gahc3 Wake Forest Nc Trs Sub, LLC | Custodial Care Facility | 3218 Heritage Trade Dr, Wake Forest, NC 27587-4238 | 2019-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831713080 | Catherine Restrepo | Speech-Language Pathologist | 900 S Franklin St, Ste 201, Wake Forest, NC 27587 | 2020-06-03 |
| 1942760277 | Samantha Fae Pugh | Occupational Therapist | 200 Dr. Calvin Jones Hwy, Suite 200, Wake Forest, NC 27587 | 2019-03-22 |
| 1851863609 | The Counseling Collective | Counselor | 1764 Heritage Center Drive, 204, Wake Forest, NC 27587 | 2018-12-18 |
| 1891270856 | Halston Hoke | Speech-Language Pathologist | 620 Dr. Calvin Jones Hwy Ste 200, Wake Forest, NC 27587 | 2018-09-26 |
| 1710465620 | Amy K Tarnowski | Physical Therapist | The Lodge At Wake Forest, 1151 South Main Street, Wake Forest, NC 27587 | 2018-08-02 |
| 1518452341 | Language and Literacy 365, Pllc | Speech-Language Pathologist | 956 Templeridge Rd, Wake Forest, NC 27587 | 2018-06-25 |
| 1467951723 | Justin Mitchell | Physical Therapist | 843 Durham Rd Suite 110, Wake Forest, NC 27587 | 2018-02-01 |
| 1124544499 | Carolina Concussion & Physical Medicine, Pllc | Chiropractor | 120 Capcom Aveune, Suite 104, Wake Forest, NC 27587 | 2017-08-18 |
| 1902293889 | Katherine Armine Lorch | Student in an Organized Health Care Education/Training Program | 3000 Rogers Road Ste 210, Wake Forest, NC 27587 | 2015-04-18 |
| 1437553302 | Raleigh Durham Medical Group, Pa | Family Medicine | 620 Dr Calvin Jones Highway, Ste 212, Wake Forest, NC 27587 | 2014-10-21 |
| Find all providers in zip 27587 | ||||
| Taxonomy Code | 311Z00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel. |
| Notes: Source: Paraphrased from Section 3159 A3 of the Medicare Intermediary Manual. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871961631 | Wake Forest Adult Day Care Inc | Custodial Care Facility | 3309 Rogers Rd, Suite 117, Wake Forest, NC 27587-3943 | 2015-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669070215 | My Guardian Angel Family Care Home | Custodial Care Facility | 514 Cokey Road, Rocky Mount, NC 27801 | 2020-10-15 |
| 1932692159 | Carillon Assisted Living of Garner LLC | Custodial Care Facility | 200 Minglewood Dr, Garner, NC 27529-5273 | 2018-06-12 |
| 1821598335 | Sonya Waddell | Custodial Care Facility | 6025 Dustin Ridge Ct, Rural Hall, NC 27045-9011 | 2018-02-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1518331669 | Carillon Assisted Living of Huntersville, LLC | Custodial Care Facility | 250 Commerce Center Dr, Huntersville, NC 28078 | 2015-11-30 |
| 1407238355 | Guardian Care Advisors, Inc. | Custodial Care Facility | 1320 Ashley Sq, Winston Salem, NC 27103-2919 | 2015-06-26 |
| 1275922171 | Freedom Ministries Church and Outreach | Custodial Care Facility | 539 Railway Place, Concord, NC 28025-0000 | 2015-01-15 |
| 1962803551 | Carillon Assisted Living of Clemmons, LLC | Custodial Care Facility | 1165 S Peace Haven Rd, Clemmons, NC 27012-8910 | 2014-09-15 |
| 1487062311 | Douglas Family Care | Custodial Care Facility | 1439 Us Highway 13 S, Ahoskie, NC 27910-8125 | 2014-07-23 |
| 1285974113 | Helping Many Lives, LLC | Custodial Care Facility | 14627 Us Highway 64, Williamston, NC 27892-8638 | 2013-03-01 |
| Find all providers with the same taxonomy | ||||
| City | WAKE FOREST |
| Zip Code | 27587 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.